Examination of Witnesses (Questions 708
- 719)
TUESDAY 22 APRIL 2008
Dr Haileyesus Getahun, Ms Diana Weil and Ms Louise
Baker
Q708 Chairman: Good
morning. We have an hour, we have to finish by ten sharp, when
we have to be out of this room. The events today are being transcribed
and you will see the transcript before it is published, so you
can correct any factual matters. If there are any issues that
we do not cover or anything you would like to add, please contact
the Clerk. Can I ask you to introduce yourselves because we were
not quite sure who was coming.
Ms Weil: We had a change of dates.
Dr Getahun: My name is Haileyesus Getahun. I
am a medical doctor by background and work as a Medical Officer
and Team Leader for TB/HIV issues in the Stop TB Department.
Ms Weil: I am Diana Weil. I am a policy analyst
of the local economy by training but am a WHO Senior Policy Adviser
for the Stop TB Department, so I work with the Director of the
Stop TB Department at WHO, which houses the Stop TB Partnership,
so we work in collaboration, which is why we are here together.
Ms Baker: I am Louise Baker. I am the Senior
Strategist for the Stop TB Partnership, which is an international
partnership housed at WHO.
Q709 Chairman:
Thank you very much. Thank you for the information you have already
given us and for coming along and giving your time today. Clearly
you are a one-disease organisation, and I would like you to start
by giving us a little summary of what you think your main purpose
and aim is other than stopping TB, which is self-evident. If you
could tell us something about the major sources of funding and
how you seek to prioritise your spending, that would be useful
to us as well, and how you work with the health systems of countries.
Who would like to start on that?
Ms Baker: I think it is probably me to start
on that.
Ms Weil: If it is a question as to the Partnership,
we will talk about the Partnership, and then we can talk about
the relationship with WHO.
Ms Baker: The Partnership is now a grouping
of more than 700 agencies from around the world, and they range
from major international organisations, so some of our major Partners—WHO
is our housing partner but there are other international agencies
that form part of the Partnership—are the World Bank, DFID,
USAID, the European Commission, et cetera. We are a large partnership.
The function of the Partnership Secretariat is to coordinate the
actions of the various partners who have made a commitment to
fighting TB. Our work is based very much on the WHO Stop TB Strategy,
but on the basis of that strategy we have a global plan to stop
TB which tries to look at TB in a fairly holistic way. So it is
looking at all aspects of countering the disease from implementation
on the ground through research, advocacy and communications. We
work on the basis of seven working groups, so our Partners are
arranged around their areas of interest. We are focused on a single
disease, absolutely, but I think we are focused on it being very
much aware that tuberculosis is a disease of poverty. So, for
example, in our working group on implementation, called DOTS expansion,
we have a subgroup on TB and poverty which is looking at social
determinant issues and poverty-related issues, so it is not looking
at it purely from a medical perspective. When you say the major
forms of funding, it is quite a complicated explanation.
Q710 Chairman:
I have worked that out!
Ms Baker: There are 700 Partners, but we are
not a funding agency. We do not channel funding particularly.
If funding comes in, we try to distribute it fairly but we do
not channel funding to our Partners. We are a loose affiliation,
a loose Partnership, with common aims and goals, but we do not
fund their major work plans.
Q711 Chairman:
That comes from where?
Ms Baker: Their own funding streams. For technical
assistance matters WHO would go out and raise its own funding
to do technical assistance for tuberculosis. Other Partners would
do the same thing. If you were a TB researcher, even though we
are all working for the same global plan, you would go out and
find your own funding for tuberculosis research. What we try to
do is make sure all the Partners speak coherently around the plan
and are aiming in the same direction. It is about coordination
and facility of a positive move rather than control. When we talk
about our sources of funding, we talk about the funding for the
Secretariat, which is housed at WHO.
Q712 Chairman:
And who funds that?
Ms Baker: Mostly bilateral donors. We get very
generous funding from the UK, we get funding from the Netherlands,
Canada, USAID, both through USAID and PEPFAR, from the Bill &
Melinda Gates Foundation. A broad range of Partners fund the work
of the Secretariat, both the work around advocacy and communications
and also the work around the Global Drug Facility and the provision
of drugs.
Q713 Lord Desai:
What is your value-added? If everybody is doing their own work,
what are you doing?
Ms Baker: OK. We are in the process of going
through an external evaluation looking at exactly that. The McKinsey
Company has come in and done an evaluation. It is avoiding duplication,
so we make sure our Partners are not doing the same thing, that
we complement each other rather than do the same thing and compete.
Certainly in the evaluation it appears that the added value of
the partnership has been about developing a common strategy so
that there is no counter-messaging. We are all very much in line
with each other and driving in the same direction, and there is
none of the squabbling that you might get if there was not a common
plan.
Q714 Baroness Whitaker:
I appreciate that your job is to make the single parts of the
engine all move in the same direction, but what happens if there
is a big organisation of any kind which is not in your 700 and
is going in a slightly different direction, which is a perfectly
reasonable thing but not helpful for some reason or another. Do
you try to draw them in? What do you do about other engines which
are going across your path?
Ms Baker: I hope we have tried reasonably successfully
to convince everybody. The process of writing the plan is almost
more important than the plan itself.
Q715 Baroness Whitaker:
Of course, I understand that. Do you have a problem with donor
preference? For instance, say a big private donor, Mr Warren Buffet,
decides he wants to do his own thing and have a really nice product
and it is not what you think ought to be done. What do you do
about that?
Ms Weil: We have a Coordinating Board. The Coordinating
Board involves members of DFID and others who collectively can
send messages. For example, they have written a letter to the
Global Fund suggesting that the Global Fund creates a seat for
the Stop TB Partnership, and there are similar discussions around
the Roll Back Malaria Partnership to represent the whole community,
so that as a Board they can collectively react to outside forces.
Q716 Baroness Whitaker:
Bring influence to bear?
Ms Weil: That is right. The other thing Louise
is bringing out is that, because we provide a coalescing of the
evidence around why we should be doing research and implementation
at the same time, we hope that is pretty convincing evidence that
we should be going on the course we are and, if not, one of the
one great elements of the partnership is that it is a place for
debate. We have had some pretty hefty debates over the years about
how to respond to certain controversial issues. How we relate
with the HIV community, which Haileyesus can discuss later, is
an important element where there has been a lot of debate, but
we are coming around to a consensus now.
Q717 Baroness Whitaker:
Broadly it works, you do get other bits not in the engine at least
going in the same direction as the engine?
Ms Baker: I think so, yes. Obviously we have
moments, there are points of conflict and debate and discussion,
but in general we all seem to agree that it is a common plan and
a common strategy. It is very strongly based on WHO's technical
strategy, so that has been a first step, and then the way of getting
there has been a process of discussion and debate.
Q718 Lord Jay of Ewelme:
Is it not a two-way street? You produce your plan and you will
communicate with some of the 700 members. But, if you are one
of the 700 members, say a small member operating somewhere in
Africa or Asia, would they be fairly regularly in touch with you?
Or would they be taking the initiative? How active would they
be?
Ms Weil: Obviously today it is a totally different
ballgame in the way that people engage, so they can become very
vocal very quickly through that means, for example civil society.
Ms Baker: What we try to do is break them down
according to working group, so there are working groups of people
working on implementing TB control in the countries and working
groups on advocacy and communications. The one I am most closely
involved with is advocacy and communications. We have a calendar
of activities that we want to get people involved in and enthusiastic
about, the key one being World TB Day which is at the end of March—24
March. Then we produce common branding, common messaging and we
communicate with our Partners and try to get them doing activities
in their countries so that they are raising awareness around a
common message.
Dr Getahun: The added value of the partnership
is particularly as Louise mentioned, the fact that it is structured
into seven working groups that have their own objectives and their
own mechanisms working in countries and at global level. The main
advantage is that the working groups bring different stakeholders
and players to a common goal, and they debate and share experiences,
and this has been very useful for the TB/HIV cause because both
communities are not homogenous, and it has helped bring them together
to discuss their issues, to debate and exchange best practices
and experience. That has been crucial to accelerating the implementation
and saving lives.
Ms Weil: In this packet you have a sheet that
is called TBTEAM, it is near the back of the materials in the
white packet. TBTEAM is a mechanism of the partnership that WHO
provides a secretariat for. What that does in this period of the
Paris Principles and development harmonisation is to try to get
all the technical partners that are helping at country level to
be sure they are not stepping on each other's toes and becoming
onerous for the government in burdening them with different policies
and different missions. If a request comes in from a country,
for example, to work on a TB/HIV proposal that is going to go
to PEPFAR or the Global Fund, to find the most experienced technical
assistance provider that is already in that country or has experience
with that country or the region to assist them, and there is general
knowledge that is who is going to assist them and it meets the
needs of the country. It is driven by the country's demand for
assistance. We know in the development field, particularly in
some fields like AIDS where you have this proliferation of people
trying to assist countries, that that is a way in which you can
get into quite a mess of overlapping missions. This is moving
into quite an evolving and solid instrument for keeping people
in touch with each other about what is happening.
Q719 Lord Avebury:
I just wanted to ask why it is not necessary to have the equivalent
mechanism for other diseases. If you say that in Stop TB the advocacy
and communications is focused through your working group, why
is there not a similar working group for, let us say, malaria?
Ms Baker: There is a similar partnership. There
is the Roll Back Malaria Partnership. They would say they attempt
to do the same thing.
Ms Weil: You could say that TB, in a way, is
a simpler field than AIDS, for example, because of the history
of how people got involved. It was a long-standing disease, there
were very deep partners who have been involved for a long time,
a lot of communication over the years, more consensus around technical
strategy and easier strategy probably. People have been reflecting
and we have all been sharing information between the AIDS, TB
and Malaria communities about how we work, and the Malaria community
has started organising working groups and now has a special envoy
from the UN similar to what we have. There is this learning from
each other across the trends. Historically, TB has had an even
history on development and that may have had to do with this technical
strategy, and clear operational technical partners that have been
in the field for a long time.
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